Say Grandma is 85 and has a long-standing history of heart disease. One night she collapses suddenly and is rushed to the hospital, where lab work shows she has elevated troponin, a finding suggestive of a heart attack. Should an autopsy be done to find out why she died? Or what if 65-year-old Dad has a history of warning strokes and one day becomes confused so he is taken to the hospital. A massive stroke is seen on imaging and he dies a few days later. Do you think the hospital could have killed him by mistake?
I'm a huge advocate of the autopsy, but sometimes it is an unnecessary procedure, particularly in cases of natural death occurring in a hospital setting. These are situations like the ones above where a patient's medical history is well known and the hospital has a pretty good idea what happened. They didn't kill the patient by accident and did all they could to save them, but the disease won out. Unfortunately, doctors are not trained how to talk to families when their loved one dies. Families often leave the hospital confused about what happened because they do not receive a thorough explanation. Doctors don't have the time or training, by no fault of their own. Death is not their business, it's uncomfortable, and more living patients than they can manage are usually making demands on their time. But this doesn't help the family. Upset, grieving family members who don't understand what happened to their loved one may demand to know answers and insist on an autopsy. A simple explanation could help to ease some of their concerns surrounding death, but in many cases, they are never given answers.
There are many good reasons to perform a hospital autopsy, particularly when the cause of death is unknown. I wrote about an example in a previous post where an autopsy revealed an undiagnosed case of meningitis. Hospital autopsies are done when a patient dies in a hospital of natural causes. They are a separate entity from forensic autopsies, which are done in cases of unnatural or suspicious death, and fall under the jurisdiction of a medical examiner or coroner's office in the United States. In some states, forensic autopsies may be performed in a hospital, but will always require the involvement of a forensic pathologist.
Hospitals do not Charge for Autopsies
Autopsies serve as a form of quality assurance for the hospital and inform families what happened to their loved one. In academic medical centers, they are a valuable teaching resource for residents, who perform the majority of the work. The hospital does not profit from an autopsy, as they are done at no charge to the family. Pathology staff will spend many hours on a single autopsy, which takes them away from their primary duty of diagnosing disease in the living. In a community hospital setting with limited resources, it is necessary to perform autopsies with discretion because the living take precedence. A delayed diagnosis on a biopsy can carry consequences.
The Hidden Cost of an Autopsy
Although hospitals perform autopsies at no cost, there may still be a financial burden associated with the procedure. Should the family of the decedent desire a viewing, it's important to know funeral homes charge more to embalm autopsied bodies. This is completely reasonable, as autopsied bodies take considerably longer to embalm, requiring additional specialized chemicals and materials. Families and physicians are often uninformed of this when they make the decision to request an autopsy.
An Invasive Procedure
The pathologist's time and the family's money are two major factors to consider when requesting an autopsy, but another is the extreme invasiveness of the procedure. Some people are not particularly concerned what happens to their body after death, but others may be. There is no privacy in an autopsy. Everything that happened over the course of a person's lifetime which left a physical mark is laid bare. A large incision is made from the neck to the pelvis and the skull is cut open. Every organ is removed and dissected. It's not something everyone would wish to undergo, particularly if it isn't necessary.
When an Autopsy is Unnecessary
Unfortunately, in some cases, an autopsy won't provide any additional answers. If Grandma died of a heart attack, there might be evidence of heart disease. Dad's stroke will be seen in the form of brain hemorrhage. Pathology will tell the physician what they initially found and issue a report a month or two later. After all of this, the physician will have to explain things to the family again, only to tell them information that was already known. If the family had been provided a thorough and compassionate explanation initially, perhaps the extra step of an autopsy could have been avoided.
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